Hospital Universitario de Guadalajara

Abdominopelvic infections remain a major diagnostic challenge despite advances in anatomical imaging. Clinical presentation is frequently nonspecific, biomarkers lack accuracy, and cross-sectional techniques such as computed tomography often fail to identify early, postoperative, or low-grade infections precisely when timely intervention is most critical. In this context, functional imaging has emerged not merely as a complementary modality, but as a decision-shaping tool capable of resolving diagnostic uncertainty. Nuclear medicine techniques provide unique pathophysiological insights that extend beyond structural assessment. ¹⁸F-FDG PET/CT offers high sensitivity for detecting metabolically active disease and is particularly valuable in identifying occult infection and guiding whole-body evaluation. However, its lack of specificity limits its ability to distinguish infection from sterile inflammation, especially in the postoperative abdomen. In contrast, radiolabeled leukocyte scintigraphy retains a critical role due to its pathogen-oriented specificity and resistance to physiological background activity in the gastrointestinal and urinary systems. Rather than competing modalities, ¹⁸F-FDG PET/CT and leukocyte imaging address complementary clinical questions: the former is optimized for detecting disease activity, whereas the latter provides confirmation of true infection. Their appropriate use should therefore be guided by the underlying diagnostic dilemma rather than by availability alone. This review examines the role of nuclear medicine in the management of abdominopelvic infections from a clinical decision-making perspective, highlighting scenarios in which functional imaging alters patient management, discussing key pitfalls, and outlining emerging approaches aimed at achieving pathogen-specific imaging.

Inflammation is a biological phenomenon beneficial for homeostasis, but it is unfavorable if dysregulated. Although major progress has been made in characterizing inflammation in specific diseases, a global, holistic understanding is still elusive. This is particularly intriguing, considering its function for human health and the potential for modern medicine if fully deciphered. In this study, we leveraged advances in single-cell transcriptomics to delineate inflammatory processes of circulating immune cells during infection, immune-mediated inflammatory diseases and cancer. Our single-cell atlas of more than 6.5 million peripheral blood mononuclear cells from 1,047 patients (56% female, 43% male) and 19 diseases allowed us to learn a comprehensive model of inflammation in circulating immune cells. The atlas expands current knowledge of the biology of inflammation of immune-mediated diseases, acute and chronic inflammatory diseases, infections and solid tumors and lays the foundation to develop a disease classification framework using unsupervised as well as explainable machine learning. Beyond a disease-centered analysis, we charted altered activity of inflammatory molecules in peripheral blood cells, depicting discriminative inflammation-related genes to further understand mechanisms of inflammation. We present a rich resource for the community and lay the groundwork for learning a classifier for inflammatory diseases, presenting cells in circulation as living biomarkers.

Despite widespread use of tumor necrosis factor inhibitors (TNFi) as first-line therapy in rheumatoid arthritis (RA), up to 40% of patients fail initial treatment. Subsequent therapeutic choices remain poorly structured, with limited evidence-based guidance to inform individualized post-TNFi decision-making. To develop evidence-informed, profile-based recommendations to guide treatment selection after inadequate response to a first TNFi in RA, combining evidence and expert consensus. Delphi-based consensus study informed by a PRISMA-guided scoping review (ScR) and nominal group methodology. A PRISMA-guided ScR of biologic and targeted synthetic biologic disease-modifying antirheumatic drug (tsDMARDs) after TNFi failure was conducted. Patient profiles were identified by a steering committee, and draft recommendations were evaluated through an anonymized Delphi process. A profile-based decision tree integrated direct and indirect evidence, with evidence strength graded using the Oxford Centre for Evidence-Based Medicine approach. The ScR included 43 studies, mostly exploratory analyses of randomized trials. Scenarios included age ⩾65 years; failure of ⩾2 TNFi; monotherapy; rheumatoid factor/anti-citrullinated peptide antibody status; prominent systemic inflammation; interstitial lung disease (ILD); rheumatoid vasculitis; high cardiovascular (CV) risk or prior CV event; venous thromboembolism (VTE) risk; obesity; high infection risk; osteoporosis; nociplastic pain, depression and fatigue; prior solid cancer; hematologic cancer/lymphoproliferative disease; non-melanoma skin cancer; and pregnancy.Seventeen recommendations were formulated; 15 achieved consensus. Agreed positions included caution with JAK inhibitors (JAKi) in older patients and in those with CV/VTE risk; preference for IL-6 receptor inhibitors or JAKi for monotherapy or prominent systemic inflammation; in RA-ILD, use a b/tsDMARD with a non-TNFi mechanism; rituximab as first choice in rheumatoid vasculitis; abatacept in infection-prone patients; discouraging JAKi in prior malignancy; and TNFi as acceptable during pregnancy. Two statements did not reach consensus: preferential use of non-TNFi in obesity and heightened caution with tofacitinib in osteoporosis or fracture risk. This Delphi-validated, profile-based framework provides a practical tool to support evidence-informed clinical decision-making.

Introduction: The evolution of higher education demands strategies that foster active student engagement and enable continuous feedback. The Exit Ticket (ET) is an effective formative assessment tool typically used at the end of a lesson to gauge both conceptual understanding and methodological satisfaction, thereby allowing instructors to adjust content and teaching strategies accordingly. However, the use and evaluation of ETs in Health Sciences education have received limited attention. This pilot study examines the participation of Health Sciences students in a digital ET supplemented with additional explanations, and assesses their perception of the tool. Methodology: An anonymous digital ET was implemented during five voluntary theoretical sessions of the Psychology and Communication course in the Dentistry Degree programme at the University of Valencia (academic year 2024–2025; n = 75). Students were asked to indicate one concept they had learned and one they had not understood. The least understood concept of each session was subsequently addressed through an online audio explanation provided before the following lesson. Afterwards, 54 students completed a 4-point Likert-scale questionnaire to evaluate the strategy. Results: An average of 30.6 students attended the lessons, of whom 78.2% completed the ET. Among the students who responded to the evaluation survey, 89.1% had attended the sessions, and they rated the usefulness of the ET positively (median = 3 across all agreement items). Students reported that the tool facilitated learning reflection and enhanced communication with the instructor, thereby improving pedagogical practice. Additionally, 18.9% of surveyed students listened to the supplementary audio recordings during the first weeks, and all of them considered these explanations useful. Conclusion: The pilot implementation of the digital ET suggests its potential in Health Sciences education to promote metacognitive reflection and support fluid, formative communication between students and instructors. This strategy appears to enable the rapid adaptation of teaching to student needs. Future research should explore its scalability, applicability to other subjects, and direct impact on learning outcomes.